F.H. is a 64-year-old female patient newly diagnosed with Pulmonary Arterial Hypertension (PAH) World Health Organization (WHO) Group 1-Functional Class III and admitted to medical ICU for treatment of her worsening PAH.

F.H. reports having increased dyspnea on exertion for the past 6 months with exercise, but for the past 3 days, she has developed severe shortness of breath at rest. She is currently not on treatment for PAH. 

a) Describe TWO most appropriate first-line options of PAH-targeted therapy to initiate for F.H. in medical ICU. 

(2 marks) 

b) While F.H. is initiated on the first-line PAH-targeted therapy, describe how you would monitor the response of PAH-targeted therapy. 

(3 marks) 

c) F.H.'s condition progressively improved while in medical ICU, describe the options of inhaled therapy for PAH that could be initiated in medical ICU. Describe the advantages of inhaled PAH-targeted therapy. 

(5 marks) 

d) In order to slow down the disease progression and reduce hospitalization, the ICU physician seeks pharmacist's consultation for adding dual combination oral therapy for WHO Functional Class III PAH as in F.H. Describe the TWO dual combination oral regimens (by drug class) you would recommend for F.H., and give ONE example of a drug in each drug class specified.

(5 marks)